The price of misplaced loyalty

Roger Kline, 5 October 2012

I spent last Tuesday in the company of 100 staff of Britain's National Health Service (NHS), three quarters of whom identified themselves as whistleblowers, many with tales of ostracism, victimisation and dismissal to tell. It was clear that whistleblowing in the NHS can seriously damage your career.

Though there are some notable high profile successes, surveys consistently show the majority of its staff believe that the NHS is often not a safe place to raise concerns about patient care or poor practice or financial skulduggery.

This is quite remarkable for two reasons. Firstly, because there is overwhelming evidence that healthcare organisations where staff feel able to raise concerns about such matters provide better and safer care and are better places to work. Secondly because the political and strategic leaders of the NHS have spent a great deal of time in recent years assuring staff and patients that whistleblowing is indeed a thoroughly virtuous and important thing to do.

Circulars, speeches, and amendments to the NHS Constitution have all stressed the importance of staff being able to raise concerns and that no detriment should be suffered for doing so. Every NHS Trust has a well publicised procedure for doing so.

Speakers from the Care Quality Commission and the General Medical Council reiterated the importance of whistleblowing and stressed that if whistleblowing had to take place, then the organisation had already failed. But it was three other speakers who made us reflect.

Kim Holt, a paediatrician sent on special leave for four and a half years by Great Ormond Street Hospital for raising staffing concerns, not long before the death of Baby Peter, described the collusion and denial that almost ended her career.

Julie Bailey, in an immensely moving and brilliantly focussed speech, described how the entire health establishment ignored and then ostracised the group of carers and relatives raising concerns about Mid Staffordshire NHS Foundation Trust. Without the determined efforts of that group, which Julie Bailey helped to found, the fact that there had been 1200 unnecessary deaths there might never have been revealed.

David Holmes, former chair of United Lincolnshire Hospitals trust, told the conference he was made redundant along with his chief executive Gary Walker after they refused to compromise patient safety in order to hit waiting list targets set by Ministers.

All three spoke with a calm authority that belied their anger. All three insisted that warm words weren’t good enough. All three spoke of the cultural change that was needed at every level of the NHS.

And all agreed that improving care and safety in the NHS needs more than whistleblowers. It needs immense cultural change underpinned by better legal protection for those who do raise concerns. In evidence to the Mid Staffordshire Public Inquiry whose delayed report is now due in January 2013, it emerged that the Trust had amended its whistleblowing policy several years ago to “remind” staff considering raising concerns that “as members of staff have a loyalty to the Trust as their employer it is important that trust between employer and employee is not compromised".

That was before the 1200 deathsthat led to the inquiry.

There is plenty of evidence about what a good employer looks like. It does not compromise its staffs’ duty of care to patients and colleagues out of a misplaced loyalty to their employer, but understands and supports that their first loyalty is to those for whom they care.